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Anatomy Year 1 > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

vasc of uterus

A

uterine A, then ovarian A

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2
Q

caput medusae

A

dilated Cutaneous veins in anterior ab wall due to:

  • portal htn
  • SVC/IVC obstruction
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3
Q

ASIS (anterior superior iliac spine) lies at the level of

A

sacral promontory

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4
Q

innervations to bladdar

A

vesical/prostatic plexus

PNS (s2-s4): contract detrusor, relax internal urethral sphincter

SNS: relax detrusor, constrict internal sphincter

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5
Q

Mesentery proper

A

dbl fold peritoneum

suspends jejunum and ilieum from post ab wall

  • The root extends diagonally from the duodenojejunal flexure to the right iliac fossa.
  • Its free border encloses the small intestine.
  • Contains the superior mesenteric and intestinal (jejunal and ileal) vessels, nerves, and lymphatics.
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6
Q

Transverse colon

A

R hepatic flexure –> L splenic flexure

largest and most mobile

txverse mesocolon attachment to posterior ab wall

N: superior & inferior mesenteric plexus

A: SMA - R, L, middle colic

V: SMV - R, L, middle colic

L: middle colic

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7
Q

lymph of duodenum

A

follow A

–pancreaticoduodenal, pyloric, superior mesenteric, and celiac lymph nodes

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8
Q

Peri-nephric abscess

A

spread to pelvis due to fascial attachment

  • DOES NOT SPREAD TO ADJ KIDNEY

causes:

  • UTI
  • staph aureus
  • DM
  • lsions of urinary tract: stones, cyst
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9
Q

Intraperitoneal Injection

A

•widely used to administer chemotherapy drugs to treat some cancers, particularly ovarian cancer.

Fluid injected into the peritoneal cavity is absorbed rapidly

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10
Q

functional “left liver” inclues

A

L lobe, caudate, quadrate lobes

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11
Q

Inguinal ligament

A

lower free border of external oblique

folds backwards on self

ASIS –> pubic tubercle

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12
Q

direct inguinal hernia

A

WEAK posterior wall of inguinal canal

No descent into scrotum

medial to inferior epigastric vessels

aquired

Older age

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13
Q

basic celiac trunk pic

A
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14
Q

Lymphatic drainage of female reproductive organs

A
  • ovary, uterine tube, and fundus follow the ovarian artery and drain into the paraaortic nodes/ lateral/ pre/ lumbar.
  • uterine body and cervix drain into the internal and external iliac nodes
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15
Q

2nd part duodenum

A

descending R of L1–L3

–major duodenal papilla on posteromedial wall = opening of hepatopancreatic ampulla

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16
Q

Thoracic esophagus

A

superior mediastium, L of median line

  • pass behind and R of aortic arch
  • desc posterior mediastinum along the right side of the descending aorta

diagphragm @ T10

  • distinct dilation before entering diaphragm
    front: trachea, aortic arch, R pulm A, L bronchus, pericardium
    behind: v-colum, longus colli M, R aortic intercostal, thoracic duct, hemiazygos V
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17
Q

Venous drainage of prostate

A

prostatic venous plexus b/w true and false capsules

connect to Batson plexus (valve less)

•Veins of most of the pelvic organs are connect to Batson plexus ( except for ovaries and testis)

  • how pelvic cancer can spread to the vertebral column
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18
Q

venous drainage of kidney

A

R & L renal V

  • anterior to A
  • L receives L suprarenal and L gonadal

drain to IVC

L passes anterior to aorta, posterior to desc SMA

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19
Q

NAVL of liver

A

N: hepatic N plexus: SNS from celiac plexus, PNS from vagus

A: portal vein (70%), hepatic (30%)

V: 3 formed by union of central veins –> drain to IVC inferior to diaphragm

L: hepatic –> celiac –> cisterna chyli

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20
Q

Subphrenic (Suprahepatic) Recess

A

pocket b/w diaphragm and anterior/superior part of liver

separated into right and left recesses by the falciform ligament.

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21
Q

innervation to large intestine

A

PNS - vagus, pelvic splachnic

SNS: T10-L2

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22
Q

N, A, V, L of scrotum

A

N:

  • anterior 1/3 = ilioinguinal, genitofemoral - genital branch
  • posterior 2/3 = pudendal, posterior cut N of thigh

A:

  • pudendal –> scrotum
  • inferior epigastric –> cremastric

V:

  • same as A

L:

  • superficial inguinal
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23
Q

Rectus sheath

A

•Aponeurosis of int. obl. splits to enclose rectus abdominis to form rectus sheath

anterior

  • above arcuate line
    • Aponeurosis of external and internal oblique
  • Below arcuate line
    • Aponeurosis of external oblique, internal oblique and transverse abdominis

posterior

  • •Above arcuate line
    • •Aponeurosis of internal oblique and transverse abdominis
  • •Below arcuate line
    • •Deficient, rectus abdominis lie on fascia transversalis
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24
Q

Nerve supply to stomach

A

PNS

  • From anterior and posterior vagal trunks.
  • Increase peristalsis and relax pyloric sphincter.

SNS

  • From T6–T9 spinal cord segments via great splanchnic nerve to celiac plexus.
  • Inhibit peristalsis and contract pyloric sphincter.
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25
Q

Visceral referred pain of stomach

A

poorly localized –> radiates to dermatome lvl

•Parietal peritoneum pain is severe and localized

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26
Q

innervation to rectum

A

pns - pelvic splanchnic

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27
Q

Paracolic Recesses (Gutters)

A

•Lie lateral to the ascending colon (right paracolic gutter) and lateral to the descending colon (left paracolic gutter).

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28
Q

prostate secretes

A

PSA

PGs

citric acid

acid phosphatase

proteolytic enz

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29
Q

Ascending colon

A

R posterior ab walll

cecum –> liver: turns @ R colic flexure (hepatic flexure)

secondarily retroperitoneal

N: superior mesenteric plexus

A: ileocolic, R colic

V: ileocolic, R colic

L: epicolic, paracolic nodes

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30
Q

Xiphoid process: located at T____

A

T9

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31
Q

complications of gastric ulcers

A

bleeding, perforation

if on posterior wall of stomach: can erod large splenic A

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32
Q

Scrotum

A
  • Cutaneous bag containing testis, epididymis and lower part of spermatic cord
  • Has six layers-skin, dartos muscle, Colles fascia, external spermatic fascia, cremasteric fascia and internal spermatic fascia
  • Dartos m. is supplied by sympathetic fibers passing through genital branch of genitofemoral nerve
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33
Q

Subhepatic Recess

A
  • Hepatorenal Recess (Morrison’s Pouch)
  • ■ Is a deep peritoneal pocket between the liver anteriorly and the kidney and suprar-enal gland posteriorly.
  • It communicates with the lesser sac via the epiploic foramen and the right paracolic gutter, thus the pelvic cavity.
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34
Q

Innervation to Adrenal glands

A

myelinated presynp SNS –> celiac plexus, thoracic splanchnic –> chromaffin cells (SNS postgang)

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35
Q

•Mesosalpinx

A

•Suspends the uterine tube

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36
Q

NAVL of Large intestines

A

N: from superior mesenteric plexus: PNS - vagus, SNS - lower thoracic SC seg

A: ileocolic

V: ileocolic

L: ileocolic

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37
Q

Suspensory ligament of the ovary

A

•connects ovary to the lateral pelvic wall

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38
Q

FIRST PART OF DUODENUM

A

•Superior

–Neck of gallbladder

–Hepatoduodenal ligament (lesser omentum)

•Inferior

–Neck of pancreas

–Greater omentum

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39
Q

Iliacus

A

O:Iliac fossa

I: lesser trochanter, femoral shaft, psoas major tendon

N: femoral

A: flex thigh, stab hip

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40
Q

•SMA syndrome

A

–Compression of the third part of the duodenum by the SMA and AA

Symptoms

  • include early satiety, nausea, vomiting,
  • extreme “stabbing” postprandial abdominal pain (due to both the duodenal compression and the compensatory reversed peristalsis
  • severe malnutrition accompanying spontaneous wasting
  • “Food fear” is a common development among patients with the chronic form of SMA syndrome
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41
Q

Coverings of spermatic cord

A

Ensheathed in three layers of tissue:

  • External spermatic fascia, an extension of the aponeurosis of the external oblique muscle
  • Cremasteric muscle and fascia, formed from a continuation of the internal oblique muscle and its fascia
  • Internal spermatic fascia, continuous with the transversalis fascia
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42
Q

•Vermiform appendix

A

–Arises from the posteromedial side of cecum

–Usually retrocecal

–Has a short mesentery from cecum: mesoappendix

–Supplied by appendicular artery from ileocolic artery

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43
Q

Hesselbach’s triangle

A

Boundaries:

•Medially

  • •Rectus abdominis

•Laterally

  • •Inferior epigastric artery

•Inferiorly

  • •Inguinal ligament

•Direct inguinal hernia occur through this

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44
Q

Intraperitoneal organs are…

A

—enclosed by peritoneum on all sides

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45
Q

Uterine and vaginal plexus

A

-drains into the uterine vein

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46
Q

Iliac crest @ what lvl of vert?

A

L4

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47
Q

portosystemic anatomoses

A
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48
Q

Secondary retroperitoneal organs are

A

start intraperitoneal

fold

end up pressed against posterior body wall

lose mesentery –> become retroperitoneal

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49
Q

Neuromuscular plane is located…

A

•Between internal oblique and transverse abdominis

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50
Q

Pudendal block

A
  • sacrospinous ligament attaches from sacrum to ischial spine
  • Pudendal n. crosses the sacrospinous ligament on its lateral aspect near its attachment to the ischial spine
  • Locate the spine, find location of the nerve for injection

-

-

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51
Q

internal oblique

A

O: thoracolumbar fascia, anterior 2/3 of iliac crest, lateral 1/2 inguinal ligament

I: ribs 10-12, linea alba, conjoint tendon to pubis

N: thoracoabdominal anterior rami of inferior 6 thoracic N, L1

A: compress, support ab viscera, flex and rotate trunk

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52
Q

•3 superficial artery from femoral artery for cutaneous anterior abdominal wall

A
  • Superficial epigastric
  • Superficial external pudendal
  • Superficial circumflex iliac
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53
Q

Intestine in Omental Bursa

A

uncommon

omental foramen –> omental bursa: may become strangulated

boundaries of foramen cannot by incised due to bv

MUST decompress intestines –> return

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54
Q

3 main branches of celiac trunk

A
  1. common hepatic
  • gastroduodenal
    • supraduodenal
    • superior pancreaticoduodenal
    • R gastro-omental
  • R gastric
  • con’t as proper hepatic
    • R hepatic
      • cystic
    • L hepatic
  1. L gastric
    * esophageal
  2. splenic
  • short gastrics
  • L gastro-omental
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55
Q

general parts duodenum

A

4 parts: 2-4 are retroperitoneal, anterolateral to L1

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56
Q

•Lateral or Transverse Cervical (Cardinal or Mackenrodt) Ligaments of the Uterus

A

extend from cervix and the vagina to the pelvic walls

extend laterally below the base of the broad ligament

support the uterus

•Main ligament that prevents the prolapse

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57
Q

hepatorenal recess

A

subhepatic recess

potential space b/w liver and R kidney

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58
Q

Rectal venous plexus

A

drains into any rectal vein

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59
Q

Abdominal Paracentesis

A

anterolateral ab wall: superior to empty bladder

avoids inferior epigastric A

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60
Q

Vesical venous plexus

A

-drains the bladder, prostate (m), deep and dorsal veins of the penis/clitoris and will drain into the inferior vesical vein

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61
Q

Sacral Plexus

A
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62
Q

Lesser omentum

A

dbl layer

porta hepatis –> lesser curv of stomach and 1st part of duodenum

  • Hepato gastric and hepatoduodenal ligaments.
  • Right free margin contains the portal triad.
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63
Q

Need to be careful during hysterectomy

A

Ureter and uterine artery relationship

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64
Q

Lesser Sac (Omental Bursa)

A
  • ■ Is an irregular space that lies behind the liver, lesser omentum, stomach, and upper anterior part of the greater omentum.
  • ■ Is a closed sac, except for its communication with the greater sac through the epiploic (omental) foramen.

•

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65
Q

indirect inguinal hernia

A

deep inguinal ring –> scrotum

  • lateral to inferior epigastric vessels

Congenital: incomplete closing of (embryonic) process vaginalis

Younger age

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66
Q

•Prostatectomy may lead to….

A

erectile dysfunction

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67
Q

•Sacrocervical Ligaments

A

•Extend from the lower end of the sacrum to the cervix and the upper end of the vagina

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68
Q

NAVL of ureters

A

N:

  • abdominal, aortic and superior hypogastric plexuses
  • pain fibers follow SNS T11-L2: referred pain to lower quad of anterior ab wall

A: branches of renal, gonadal, aorta, common iliac

V: renal, gonadal

L:

  • follow renal V –> lumbar lymph nodes (caval &aortic)
  • middle –> common iliac nodes
  • inferior –> common, external, iliac nodes
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69
Q

vasc supply to adrenal glands

A

A:

  • superior suprarenal A (6-8) from inferior phrenic
  • middle suprarenal artery from the aorta
  • inferior suprarenal artery from the renal artery

V: suprarenal vein –>

  • R: IVC
  • L: L renal
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70
Q

lymph drainage to rectum

A

upper rectum: superior rectal –> inferior mesenteric –> aortic

lower: internal iliac

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71
Q

Epiploic or Omental (Winslow’s) Foramen

and boundaries

A
  • natural opening between the lesser and greater sacs.
  • ■ Is bounded superiorly by peritoneum on the caudate lobe of the liver, inferiorly by peritoneum on the first part of the duodenum, anteriorly by the free edge of the lesser omentum, and posteriorly by peritoneum covering the IVC.
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72
Q

inguinal ring: superficial and deep

A
  • Superficial inguinal ring
  • Triangular gap in external oblique aponeurosis situated superomedial to pubic tubercle
  • Deep inguinal ring
  • Lies in fascia transversalis just lateral to inferior epigastric vessels
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73
Q

Peritonitis

A
  • Bacterial contamination of the peritoneum.
  • Causes: Trauma, infection, appendicitis, perforation an ulcer.
  • Generalized peritonitis is dangerous.
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74
Q

Parietal peritoneum

A

internal surface of the abdominal and pelvic wall.

same NAVL as region of the wall it lines

pain, heat, cold and laceration.

Pain = well localized

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75
Q

0Anterior abdominal wall

A
  • Part of trunk below diaphragm
  • Divided by plane of pelvic inlet
  • •Larger upper part abdomen proper
  • •Smaller lower part true pelvis

•Contents

  • •Large part of the digestive and urogenital system
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76
Q

celiac A supply

A
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77
Q

recesses of lesser sac

A
  • Presents three recesses:
  • (1) superior recess, which lies behind the stomach, lesser omen-tum, and left lobe of the liver;
  • (2) inferior recess, which lies behind the stomach, extending into the layers of the greater omentum.
  • (3) splenic recess, which extends to the left at the hilus of the spleen.
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78
Q

recesses of liver

A

subphrenic: split yb falciform ligament, sep liver from diaphragm
hepatorenal: R side, sep anterior from kidney, post by adrenal gland

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79
Q

Hiatal hernia

A

stomach to mediastinum via esophageal hiatus

•More common in middle aged people.from weak muscles.

  1. paraesophageal
    * cardia remains in normal position, only esophagus moves
  2. sliding
  • clamping of R crus of diaphragm = weak
  • ab esophagus, cardia, parts of fundus of stomach
    • esp when person lying down, bends over
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80
Q

Constituents of spermatic cord

A
  • Ductus deferens
  • Testicular, cremasteric, and artery to ductus deferens
  • Pampiniform plexus of veins
  • Lymph vessels from testis
  • Genital branch of genitofemoral nerve and sympathetic plexus
  • Remains of processus vaginalis
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81
Q

Cryptorchidism

A

•Undescended testis

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82
Q

ligaments of liver

A

•Falciform ligament

–Peritoneal reflection from upper anterior abdominal wall from umbilicus to liver

–Has ligamentum teres hepatis (round ligament) in free edge

•Ligamentum teres hepatis (round ligament of liver)

–Fibrous remnant of umbilical vein

–Extended from umbilicus to liver

•Ligamentum venosum

–Remnant of the ductus venosus

–Extended in fetus between the umbilical vein and inferior vena cava (IVC)

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83
Q

LIVER general characteristics

A

covered by peritoneum except @ porta hepatis and bed of gall bladder

related to:

–Right side of anterior stomach

–First part of duodenum

–Gall bladder

–Right colic flexure and transverse colon

–Right kidney and suprarenal glands

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84
Q

•Round Ligament of the Uterus

A

•Attached to the uterus in front of and below the attachment of the uterine tube

•Remnant of Gubernaculum!

  • Holds the fundus of the uterus forward, keeping the uterus anteverted and anteflexed
  • Enters the inguinal canal at the deep inguinal ring, emerges from the superficial inguinal ring, and becomes lost in the subcutaneous tissue of the labia majora
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85
Q

Esophagus in general

extends what on vertebrae

A

C6 –> T11/12

most narrow @ start and when it passes through diaphragm

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86
Q

Vagina fornix

A

forms the recess between the cervix and the wall of the vagina

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87
Q

INTERNAL STRUCTURE OF KIDNEYS

A

Cortex

  • Outer layer
  • Contains: glomerulus, renal corpuscle, proximal and distal convoluted tubules, proximal collecting ducts

Medulla

  • Inner layer
  • Divided into medullary pyramids
  • Contains: thick and thin limbs of loops of Henle, distal parts of proximal and distal convoluted tubules, distal collecting ducts
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88
Q

lobes of prostate

A
  • Anterior lobe (or isthmus): front of the urethra, no glandular substance
  • Middle (median) lobe: between the urethra & ejaculatory ducts, prone to BPH = block internal urethral orifice
  • Posterior lobe: behind the urethra & below ejaculatory ducts, prone to carcinomatous transformation
  • Right and left lateral lobes: either side of the urethra = main mass of the gland
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89
Q

where is the Site for portocaval anastomoses

A

Hemorrhoids

hemorrhoids

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90
Q

Posterior Branch of internal iliac

A
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91
Q

Porta hepatis

A

txverse fissure on visc surf b/w caudate and quadrate lobes

•Provides entrance/exit for:

–Portal vein

–Hepatic artery

–Hepatic ducts (left and right converge to form the common hepatic duct)

–Hepatic nerve plexus

–Lymphatic vessels

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92
Q

Ureters

A

retroperitoneal

surface marking: 5cm lateral to L1 SP and PSIS

constricted @ 3 sites:

  • jxn ureter and renal pelvis
  • cross pelvic brim, external iliac A
  • wall of urinary bladdar
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93
Q

Pelvic Inlet vs. Pelvic Outlet

A
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94
Q

Peptic ulcer: palp in what region of the ab?

A

epigastrium

95
Q

Pouch of Douglas

A

rectouterine pouch

fold of peritoneum b/w rectum and uterus

behind posterior fornix of vagina

contains peritoneal fluid and some of small intestines

96
Q

cremasteric reflex test

A

L1-L2

The genital branch of genitofemoral n. innervates the cremasteric muscle

97
Q

Bone marrow harvest

A

Posterior aspect of iliac crest

98
Q

•Pheochromocytoma

A

uusally benign tumor of adrenal medulla

exaggerated SNS activity: excess secr of epi, NE

99
Q

Innervation of Kidneys

A

renal plexus

formed from:

  • celiac plexus
  • aorticorenal ganglia
  • least splanchnic N
  • aortic plexus
100
Q

Planes of abdomen

A

Subcostal plane:

  • Passes below costal margin of each side (10th cc)
  • Post. passes through L3 (upper border)

Transtubercular plane:

  • Passes through tubercles of iliac crest and body of L5 near its upper border

Midclavicular plane:

  • Crosses the tip of 9th cc and midinguinal point
101
Q

Visceral peritoneum

A

same NAVL as organ it covers

stretching, chemical irritation

  • insensitive to touch, heat and cold, and laceration (pareital)

pain = poorly localized

  • dermatomes of sensory fibers.
102
Q

pancreatic duct

A

main: tail –> head

  • joins common bile duct –< hepatopancreatic ampulla (of Vater)
    • surr by sphincter of Oddi
    • major duodenal papilla

accessory:

  • connect to main 60% time
    • can be main duct for panc secr
  • opens at summit of minor duodenal papilla

variations due to fusion/lack of fusion of dorsal and ventral panc ducts during emb

103
Q

Cremasteric reflex

what N lvl is tested?

A

stroking the skin of upper part of medial side of thigh, testis are elevated

L1

104
Q

•Skin of ant. abd wall is supplied by

A
  • T7-T11 intercostal and T12 as subcostal and L1 as Iliohypogastric
  • Ant. cut nerves pierce the ant. surface of rectus sheath close to median plane
  • •T7 near xiphoid process
  • •T10 around umbilicus
  • •Iliohypogastric 1 inch above the sup. ing. ring
105
Q

Transpyloric plane

A
  • Passes anteriorly to the tip of 9th cc
  • Post. lower border of L1 vertebra
  • Marks the midway of suprasternal notch and pubic symphysis
106
Q

ligaments of the liver

A
107
Q

anterior ab wall layers

A

skin

camper fascia: superficial fatty laterof subcut tissue

scarpa fascia: deep membranous layer of subcut tissue

investing fascia

external oblique

intermediate investing fascia

internal oblique

deep investing fascia

transversus abdominis

transversalis fascia

extraperitoneal fat

pareital peritoneum

108
Q

Calot’s triangle

A

cystic duct, the common hepatic duct, and the cystic artery

•Mascagni’s lymph node or Lund’s node

  • freq enlarged due to colescystitis or cholangitis (biliary tract)

can contain aberrant/accessory R hepatic A or anomalous sectoral bile ducts

dissection = #1 cause of common bile duct injuries

109
Q

Orchitis

A

•Inflammation of testes

110
Q

blood supply to bladdar

A
  • Superior and inferior vesical arteries (and from the vaginal artery in females)
  • Venous blood is drained by the prostatic (or vesical) plexus of veins, which empties into the internal iliac vein
111
Q

Inguinal ligament runs

from

A

ASIS to pubic

tubercle

112
Q

Jejunum

A
  • Approximately two fifths of the length of jejunum/ileum
  • Mainly LUQ
  • Thick-walled and very vascular
  • Plicae circularis
  • No peyers patches
  • Less prominent arterial arcades
113
Q

Megacolon

A

•abnormal dilation of the colon –> paralysis of the peristaltic movements of bowel

  • Congenital or aganglionic

•Fecolomas are common

acute or chronic

acquired:

  • idiopathic, toxic, secondary to infection (c. diff)
114
Q

Pyrosis

A

“heartburn”

  • most common type of esophageal discomfort.
  • Is usually the result of regurgitation of small amounts of food or gastric fluid into the lower esophagus.
  • Causes: certain foods, GERD, hiatal hernia, certain drugs
115
Q

Umbilicus

A
  • Scar of umbilical cord
  • Lies at junction of L3&L4
  • Not a constant landmark
116
Q

Esophagogastric junction

A

L of T11

z-line: muscosa from esophageal to gastric

diaphragmatic musculature forming esophageal hiatus functions as a physiological inferior esophageal sphincter that contracts and relaxes

117
Q

common iliac Arterial Circulation

A
118
Q

general rectum

A

sigmoid colon –> anal canal

Ampulla: lower dilated part, above the pelvic diaphragm, stores feces

no Peritoneal covering for distal third

anterior to the sacral plexus ( Sciatic nerve) and piriformis

119
Q

Pancreas

A

retroperitoneal

exocrine: dig jucies
endocrine: insulin, glucagon

head:

  • encircled by c-shaped curve of duodenum
  • overlies IVC, R & L renal V, R renal A
  • uncinate process

neck:

  • overlies SMA/SMV
  • adj to pylorus
  • SMV joins splenic V –> portal V posterior to neck

body:

  • crosses body of l2, aorta
  • floor = omental bursa
  • post to stomach
  • anterior to: SMA, L adrenal, L kidney
120
Q

NAVL to pancreas

A

N: vagus, thoracic splanchnic

A: splenic (main),

–gastroduodenal> superior pancreaticoduodenal

– superior mesenteric>inferior pancreaticoduodenal arteries

V: splenic (main) –> SMV –> portal

L: pancreaticosplenic

121
Q

Pampiniform plexus

A

-(m)

forms around the testicular artery in the scrotum and drains into the testicular vein

122
Q

NAVL of testis and epididymis

A

N: autonomic: PNS - vagus, SNS - T7

A: testicular

V: pampiniform plexus –> becomes testicular as it ascends through inguinal canal

  • R into IVC
  • L into L renal

L: paraortic

123
Q

Suprarenal glands

A

right gland

  • pyramidal
  • anterior to R crus diaphragm
  • contacts IVC, liver

left gland

  • cresent/semilunar
  • contacts: spleen, stomach, L crus of diaphragm

enclosed by renal fascia –> attach to crura of diaphragm

  • sep from kidneys via septum (part of fascia)
124
Q

Pylorus

A
  • Begins at level of angular incisure: indentation 2/3 of way along lesser curvature.
  • Widest region = pyloric antrum –> leads to pyloric canal.
  • Pyloric sphincter

–Thick, circular middle layer of muscularis externa.

–Controls passage of chime into duodenum.

–Normally closed in tonic contraction, except during peristalsis.

125
Q

Peritoneal Adhesions

A

dmg –> imflammed peritoneal surf –> sticky with fibrin –> healing –> fibrin replaced with fibrous tissue –> adhesions –> chronic pain

126
Q

NAVL to gallbladder

A

N: SNS - celiac plexus, PNS - vagus, sensory from R phrenic

A: cystic A from R hepatic

V: cystic –>

  • neck and biliary ducts –> portal vein
  • body/fundus –> directly into liver

L: hepatic

127
Q

Adhesiotomy

A
  • Adhesiotomy refers to the surgical separation of adhesions.
  • Adhesions are often found during dissection of cadavers.
128
Q

Greater omentum

A

dbl layered: greater curvature –> txverse colon

embryonic dorsal mesentery

right and left gastroepiploic vessels

ligaments: gastro–

  • phrenic
  • lineal
  • colic
129
Q

Lymphatics of stomach

A

gastric, gastroepiploic, pancreaticosplenic, and pyloric nodes.

130
Q

kidney stones

A

Pain in pararenal region-

  • close relation of kidneys to psoas muscle
  • extension of hip

Renal ureteric CALCULI-

  • severe intermittent pain (ureteric colic)
  • referred to inguinal, lumbar or external genitals as stone progresses
131
Q

lienorenal ligament

A

splenic A

splenic V

tail of pancreas

132
Q

Sigmoid Mesocolon

A
  • Connects the sigmoid colon to the pelvic wall and contains the sigmoid vessels.
  • Its line of attachment may form an inverted V.
133
Q

NAVL of esophagus

A

N:

  • vagus, SNS trunks
  • lower portion surr by esophageal N plexus

A:

  • upper 1/3 - inferior thyroid
  • middle 1/3 - desc thoracic aorta
  • lower 1/3 - L gastric

V:

  • upper 1/3 - inferior thyroid
  • middle 1/3 - azygos
  • lower 1/3 - L gastric

L:

  • upper 1/3 - deep cervical
  • middle 1/3 - mediastinal
  • lower 1/3 - nodes along L gastric bv, celiac
134
Q

H. pylori infection

A
  • Infection of the stomach mucosa
  • Causes : abdominal pain, gas, bloating, badbreath, heart burn, nausea and gastric ulcer
135
Q

Ileum

A

approx 3/5 length of jejunum/ileum

mainly RUQ

thin-walled, less vasc than jejunum

term @ ileocecal jxn

PEYERS PATCHES

more artieral arcardes, more fat than jejunum

136
Q

gastrosplenic ligament contains

A

left gastro-epiploic

short gastric A

137
Q

N supply to duodenum

A

PNS: vagus via celiac and superior mesenteric plexuses

SNS: celiac and superior mesenteric plexuses, traveling on pancreaticoduodenal arteries

138
Q

innervation to vagina

A

uterovaginal plexus = upper 3/4

deep perineal branch of pudendal N = lower 1/4

139
Q

Inferior mesenteric artery

A

L2-3

•Left colic artery

–Runs to the left and divides into ascending and descending branches

•Sigmoid arteries

–2-3 in number

•Superior rectal artery

–Divides into two

–Branches that run along the sides of the rectum and anastamoses with middle rectal arteries

140
Q

Large intestines characteristics

A

teniae coli: 3 thickened long bands of M

  • Haustra: sac of the colon caused by teniae coli

•Appendices epiploicae: fatty lobules of omentum

  • Cecum Blind pouch, approximately 7.5 cm in diameter
  • No mesentery, but may be bound to the abdominal wall by cecal folds of peritoneum
  • Invaginated by ileum to form the ileocecal valve—does not prevent reflux
141
Q

Cervical esophagus

A

front: trachea
back: v-column, longus colli M
sides: common carotid A, lobes of thyroid
* L: thoracic duct

recurrent nerves ascend between it and the trachea

142
Q

Medulla of suprarenal glands

A

emb: neural crest

secretes:

  • catecholamines- epinephrine and norepinephrine
  • SNS response: increase HR & BP, dilates bronchioles
143
Q

x-sec layers of kidney

A
144
Q

Costal margin:

Formed by

A

•7th, 8th, 9th, 10th costal cartilages

145
Q

•Prostate cancer

A

•Slow-growing cancer that occurs particularly in the posterior lobe

146
Q

Hilum of kidney

A

Renal artery enters

Renal vein (artery posterior to vein) and renal pelvis (posterior to vessels) exit

  • renal pelvis: expansion of prox end of ureter

renal sinus

147
Q

Linea semilunaris

A
  • Curved groove marks the lateral border of rectus abdominis
  • Extends from tip of 9th costal cartilage to pubic tubercle
148
Q

4th part of duodenum

A

ascending

  • ascends to L2 of L side
  • Curves anteriorly at duodenojejunal flexur
    • supported by the ligament of Treitz

–posterior to the root of the mesentery, parts of the jejunum;

–anterior to the left psoas muscle;

–lateral to the head of the pancreas (on the left side); and

–inferior to the body of the pancreas.

149
Q

Testicular torsion

A
  • Twisting of spermatic cord and testis within scrotum
  • Result in blockage of blood supply to testis
  • Causes severe pain, swelling and reddening of scrotum
150
Q

psoas minor

A

O: vert-body of T12

I: iliacus M –> forms iliopsoas M

N: anterior ramus of L1

A: flex trunk

151
Q

landmarks of kidney

A
152
Q

Varicocele

A

•Dilated pampiniform plexus of veins

153
Q

arc of Riolan

A

meandering mesenteric artery or central anastomotic mesenteric artery.

connects middle colic branch of SMA –> L colic branch of IMA

can be occluded, sig stenosis

  • prox SMA: collat flow from IMA –> SMA
  • prox IMA: collat flow from SMA –> IMA
154
Q

psoas major

A

O: TP L1-5

I: lesser trochanter of femur

N: anterior rami L1-3

A: flex thigh, stab hip joint

155
Q

Mesoappendix

A

•Connects the appendix to the mesentery of the ileum and contains the appendicular vessels.

156
Q

Congenital hypertrophic pyloric stenosis

A

hypertrophy of pylorus –> narrowing pyloric canal – slow gastric empty –> dilation of prox stomach

forceful vomitting, dehydration, wt loss

babies may seem to be hungry all the time

157
Q

Gastric ulcer

A

dull aching pain, often right after eating

  • upper ab, below breastbone

not relieved by eating

  • LIKE OVER TYPES OF ULCERS

indigestion, heartburn, acid reflux, episodic nausea, loss of apetite

158
Q

common clinical of scrotum

A
  • Common site of edema due to laxity of skin and dependent position
  • Common site of sebaceous cyst due to abundance of sebaceous gland
  • Hydrocele: Accumulation of fluid in tunica vaginalis

elephantitis

159
Q

NAVL to spleen

A

N: celiac plexus

A: splenic (twisted from celiac trunk)

V: splenic –> SMV –> portal

L: pancreaticosplenic

160
Q

3rd part duodenum

A

horizonal:

  • crosses IVC, aorta, L3, R psoas major M
  • crossed by SMA, SMV, root of mesentery, head of pancreas (R side)
161
Q

Appendicitis: palp in what ab region?

A

right inguinal

162
Q

Innominate Bone

A

hip bone

163
Q

quadratus lumborum

A

O: 12th rib

I: iliolumbar lig, iliac crest

N: ventral rami T12-L3

A: extension and lateral flex of trunk

164
Q

Fluid in omental
bursa

A

perforation of posterior wall of stomach

inflammed/injured pancreas –> panc pseudocyst

165
Q

Muscles of the Posterior Abdominal Wall

A

Iliopsoas:

—Psoas Major

—Psoas Minor

—Iliacus

Quadratus lumborum

166
Q

boundaries of inguinal canal

A

Ant. Wall:

•External oblique aponeurosis, reinforced laterally by internal oblique aponeurosis

Post wall:

•Fascia transversalis laterally & conjoint tendon medially

Roof:

•Arching fibers of internal oblique and transverse abdominis

Floor:

•Inguinal lig and lacunar ligament medially

Structures passing:

  • Spermatic cord in males and round lig. of uterus in female
  • Ilioinguinal nerve
167
Q

Ascites

A
  • Excessive fluid in the peritoneal cavity.
  • Causes: portal hypertension, metastasis of cancer cells, starvation.
  • The excessive fluid interferes with movement of the viscera.
168
Q

Cortex of suprarenal glands

A

emb: mesoderm:

secretes:

–Glucocorticoids

–Mineralocorticoids

–Androgens

–Maintains blood volume and blood pressure

169
Q

Epididymis

A

highly coiled tubes lying posterior to testis

  • Head is composed of highly coiled efferent ductules. Body and tail has a single duct
  • At lower end of tail duct become continuous with ductus deferens
170
Q

Retroperitoneal organs are

A

—organs that are only covered on their anterior surface by peritoneum (think kidneys)

171
Q

transverse abdominal

A

O: costal cartilages ribs 7-12, thoracolumbar fascia, iliac crest, lateral 1/3 inguinal ligament

I: linea alba, aponeurosis of internal oblique, conjoing tendon to pectin pubis

N: thoracoabdominal anterior rami of inferior 6 thoracic N, L1

A: compress and support ab viscera

172
Q

fissures of liver

A
  • H shaped fissures made up of the following
  • Round ligament
  • Fissure of the ligamentum venosum
  • Fossa for the gallbladder
  • Fissure for IVC
173
Q

Secondary Retroperitoneal Organs examples

A

—Pancreas

—Duodenum (parts 2-4)

—Ascending Colon *

—Descending Colon*

* The appendix, lower end of the cecum and sigmoid colon are not considered retroperitoneal.

174
Q

•Ileocecal Fold

A

•Extends from the terminal ileum to the cecum.

175
Q

Kidneys

A
  • Remove excess water, salts, products of protein metabolism
  • Kidneys, ureters, their vessels, and the suprarenal glands are primary retroperitoneal structures of the posterior abdominal wall

T12-L3, ribs 11-12

L kidney higher than R

perirenal fat: continuous at hilum with fat in the renal sinus

pararenal fat: external to renal fascia

176
Q

•Umbilical Folds

A

five folds of peritoneum below the umbilicus

177
Q

vasc supply to duodenum

A

A:

  • Gastroduodenal artery, branch of common hepatic → superior anterior and posterior pancreaticoduodenal arteries
  • SMA → anterior and posterior inferior pancreaticoduodenal arteries
  • Important anastomoses between celiac trunk and SMA via duodenal arteries

V:

  • follow A
  • Drain directly or indirectly into the portal vein
178
Q

Cholecystitis: palp in what region of the ab

A

right hypochondriac

179
Q

•Pubocervical Ligaments

A

•posterior surface of the pubis to the cervix of the uterus

180
Q

Pelvic Sexual Dimorphism

A
181
Q

•Hypertrophy of the prostate

A

BPH

most often in middle lobe

obstructs internal urethral orifice –> nocturia, dysuria, urgency

may compress the ejaculatory duct and may have problem in emission!

182
Q

A supply to Kidneys

arterial tree

A

R & L renal A

  • branches of aorta @ L1/L2
    • R passes post to IVC
  • anterior to renal pelvis
  • Renal artery
  • Segmental artery
  • Lobar artery
  • Arcuate
  • Interlobular
  • Afferent arteriole
  • Glomerulus
  • Efferent arteriole
183
Q

•Mesovarium

A

part of broad ligament

connects anterior surf of ovary with post layer of broad lig

184
Q

Nutcracker syndrome

A

most commonly from the compression of the left renal vein between the abdominal aorta (AA) and superior mesenteric artery (SMA)

•associated with hematuria (which can lead to anemia), abdominal pain(classically left flank pain).

  • left testicular pain in men
  • •left lower quadrant pain in women.
  • Nausea and vomiting can result due to compression of the splanchnic veins
  • An unusual manifestation of NCS includes varicocele
185
Q

Spleen

A

LUQ

largest lymph organ: ribs 9-11 (sep by diaphragm)

ligaments:

  • gastrosplenic, splenorenal
  • attached to hilum

sits on phrenicocolic ligament (sustentaculum lienis)

Anterior: stomach (gastrosplenic ligament)

Posterior: diaphragm

Inferior: splenic flexure of colon

Medial: left kidney (splenorenal ligament)

Tail of pancreas extends to hilum

186
Q

Uterine Tubes

A
  • Fertilization usually takes place in the ampulla –> Danger of Tubal pregnancy
  • Subdivided into four parts
  • Uterine part
  • Isthmus
  • Ampulla
  • Infundibulum
187
Q

blood supply to vagina

A

uterine A

interal iliac A

188
Q

func of rectus sheath

A
  • Checks bowing of rectus muscle during contraction –> increase efficiency
  • Maintains strength of ant. abd. wall
189
Q

Ejaculatory Ducts

A

•union of the ductus deferens and the seminal vesicles

peristaltic contractions of musc layer –> propel sperm with seminal fl –> urethra

•Open into the prostatic urethra on the seminal colliculus just lateral to the blind prostatic utricle

190
Q

Portal vein

A

formed by:

  1. splenic
    * IMV, pancreatic, L gastroepiploic, short gastric
  2. SMV
    * –Inferior pancreaticoduodenal, R gastroepiploic, R colic, ileocolic, jejunal, ileal

drains directly into:

  • cystic, superior pancreaticoduodenal, R & L gastric
191
Q

Broad Ligament

A
  • Two layers of peritoneum, extends from the lateral margin of the uterus to the lateral pelvic wall, and serves to hold the uterus in position
  • Contains the uterine tube, uterine vessels, round ligament of the uterus, ligament of the ovary, ureter (lower part), uterovaginal nerve plexus, and lymphatic vessels
192
Q

Ductus Deferens

A
  • Begins from the epididymis
  • In the spermatic cord in the inguinal canal
  • Enters the pelvis at the deep inguinal ring
  • Loops around the ureter near the wall of the bladder, and is dilated to become the ampulla at its terminal part
193
Q

Rectovesical/Vesicouterine Pouch

A
  • Rectovesical pouch
  • Peritoneal recess between the bladder and the rectum in males
  • Vesicouterine pouch
  • Peritoneal sac between the bladder and the uterus in females
194
Q

lymphatics of adrenal glands

A

plexuses in medulla, deep to gland capsule –> many to lumbar

195
Q

Transpyloric plane (11)

A
  • lumbar vertebra 1 and hence passes just before the end of the spinal cord in adults.
  • the fundus of the gallbladder
  • the end of the spinal cord
  • the Neck of pancreas
  • the origin of the superior mesenteric artery the left and right colic flexure
  • the root of the transverse mesocolon
  • duodenojejunal flexure
  • the 1st part of the duodenum
  • the upper part of conus medullaris
  • the spleen
  • the pylorus of the stomach which will lie at this level approximately 5 cm to the right of the midline.
196
Q

Testes

A

Male gonad, lie in scrotum suspended by spermatic cord

Produce spermatozoa and testosterone

surrounded by a double layered serous sac, called tunica vaginalis

sep by fibrous septa to divide into 200-300 lobules

  • each lobule = 1-3 seminiferous tubules –> join to form straight tubule –> netwk called rete testes –> small efferent ductules to upper end of epididymis
197
Q
A
  • Situated below the peritoneum
  • Extends upward above the pelvic brim as it fills
  • Apex: anterior end
  • Fundus/base: posteroinferior triangular portion
  • Neck: where the fundus and inferolateral surfaces come together, leading into the urethra
  • Uvula: small eminence at the apex of its trigone, projecting into the orifice of the urethra
  • Trigone: bounded by the two orifices of the ureters and the internal urethral orifice, around which is a thick circular layer called the internal sphincter
  • Has bundles of smooth-muscle fibers known as the detrusor muscle
198
Q

Rectum Blood Supply

A
  • Superior (IMA), middle( IIA), and inferior rectal arteries(IPA) and the middle sacral artery
  • Superior rectal artery pierces the muscular wall and courses in the submucosal layer and anastomoses with branches of the inferior rectal artery
  • Middle rectal artery supplies the posterior part of the rectum
  • Venous blood returns to the portal venous system via the superior rectal vein and to the caval (systemic) system via the middle and inferior rectal veins
199
Q

Ligament of the ovary

A

•connect ovary to uterus, remnant of gubernaculum

200
Q

True (Lesser) vs. False(Greater) Pelvic Cavity

A
201
Q

vasc of ovaries

A

ovarian A –> contained in suspensory ligament

ovarian V

  • R: –> IVC
  • L –> left renal vein
202
Q

Linea alba

A
  • Median furrow extending from Xiphoid process to pubic symphysis
  • Sometime epigastric hernia occur through it
203
Q

Marginal Artery of Drummond

A

vasc arcade that connects SMA and IMA

204
Q

NAVL to jejunum and ileum

A

N:

  • PNS: vagus: synpase on postgang cells in myenteric and submucosal plexuses
  • SNS: pregang from T5-T9 –> greater and lesser splanchnic N –> post gang celiac and superior mesenteric ganglia

A:

  • SMA:
    • 15-18 branches –> forms arterial arcades (loops/arches) –> vasa recta (straight A)
    • dbl row of arcades to ileum

V:

  • SMV
  • Posterior to neck of pancreas joins splenic vein to form portal vein

L:

  • lacteals - absorbs fat –> lymph plexus –> b/w layers of mesentery –> mesenteric lymph node –> superior mesenteric/ileocolic nodes –> cisterna chyli
205
Q

location of Renal angle

A

b/w rib 12 and lateral margin of erector spinae

206
Q

Descending colon

A

L posterior ab wall

splenic flexure –> sigmoid colon

secondarily retroperitoneal

N: SNS - lumbar sympath trunk & superior hypogastric plexus; PNS = pelvic splanchnic

A: IMA: L colic, superior sigmoid

V: IMV: L colic, superior sigmoid

L: epicolic, paracolic

207
Q

gallbladder

A

fossa @ jxn of R and L lobes of liver

fundus @ 9th costal cartilage

body @ txverse colon, first part of duodenum

neck: spiral valve (spiral fold of mucosa) that keeps cystic duct open

cystic duct –> common hepatic duct : becomes common bile duct

208
Q

Conjoint tendon is which line?

what are the other lines?

A

3rd line = conjoint tendor

2nd line = ilioinguinal N

1st line = illiohypogastric N

forms lowest aponeurosis of internal oblique and transversis abd

attached to pubic crest

suports superficial inguinal ring

209
Q

visc referred pain pic

A
210
Q

name arrows in inguinal canal

A
211
Q

Greater Sac

A
  • ■ Extends across the entire breadth of the abdomen and from the diaphragm to the pelvic floor and presents numerous recesses into which pus from an abscess may be drained.
    1. Subphrenic (Suprahepatic) Recess
    1. Hepato renal recess (Morrisons pouch)
    1. Paracolic recess
212
Q

Abdominal esophagus

A

•esophageal groove on the posterior surface of the left lobe of the liver.

antrum cardiacum

  • conical base due to compression by upper orifice of stomach

front and L aspects covered by peritoneum

213
Q

external oblique

A

O: ribs 5-12

I: linea alba, pubic tubercle, anterior 1/2 iliac crest

N: thoracodbdominal N (T7-T11), subcostal

A: compress, support ab viscera, flex and rotate trunk

214
Q

rectus abdominis

A

O: pubic symphysis, pubic crest

I: xiphoid, costal cartilages 5-7

N: thoracoabdominal nerves and anterior rami of inferior thoracic N

A: flex trunk (lumbar vert), compress ab viscera, stab & controls tilt of pelvis

215
Q

Anterior Branch of internal iliac

A
216
Q
A

Mc Burney’s point

R abdomen: 1/3 distance from ASIS –> navel

most common loc of base of appendix where it attaches to cecum

217
Q

Transverse Mesocolon

A
  • Connects the posterior surface of the transverse colon to the posterior abdominal wall.
  • Fuses with the greater omentum to form the gastrocolic ligament.
  • Contains the middle colic vessels, nerves, and lymphatics.
218
Q

contents of rectus sheath

A

2 muscles: Rectus abd.& pyramidalis

2 arteries: SEA, IEA

2 veins: SEV, IEV

6 nerves: Lower 6 intercostal nerves

219
Q

Sigmoid colon

A

sigmoid mesocolon

N: SNS - –lumbar sympathetic trunk and superior hypogastric plexus; PNS - pelvic splanchnic

A: IMA: L colic, superior sigmoid

V: IMV: L colic, superior sigmoid

L: epicolic, paracolic

220
Q

lymph drain of vagina

A

upper 3/4 = internal iliac nodes

lower 1/4, below hymen = down to perineum –> superficial inguinal

221
Q

Uterus

A

•Normally:

  • anteverted (angle of 90 degrees at the junction of the vagina and cervical canal)
  • anteflexed (angle of 160 to 170 degrees at the junction of the cervix and body)

•Retroverted and retroflexed: NOT NORMAL

222
Q

Vasectomy

A

•Ductus deferens is ligated bilaterally when sterilizing a man

223
Q

cystohepatic triangle

A

the area bound by the cystic duct, common hepatic duct, and the liver margin.

224
Q

Prostatic urethra receives

A

ejaculatory duct

225
Q

Testicular cancer

A
  • Common in undescended testis
  • Metastasize to paraortic lymph node
226
Q

•Mesometrium

A

•Below the mesosalpinx and mesovarium

227
Q

lymph drainage of prostate

A

internal iliac nodes

228
Q

•Rectouterine Fold

A

e•xtends from the cervix of the uterus, along the side of the rectum, to the posterior pelvic wall, forming the rectouterine pouch (of Douglas).

229
Q

Subphrenic abscess

A

accumulation pus/fluid in space b/w diaphragm, spleen, and liver

dev after sx: splenectomy, bowel perforation, appendicitis

  • 1/2 on R, 1/4 on L, 1/4 on both sides
230
Q

Seminal Vesicles

A

lower end has ducts –> join the ampullae of the ductus deferens to form the ejaculatory ducts

inferior and lateral to ampullae of ductus deferens aga fundus of bladder

alkaline portion of seminal fluid : fructose and choline

231
Q

Esophageal constrictions

A

cervical: upper esophageal sphincter

  • pharyngoesophageal jxn: 15cm from incisors
  • caused by cricopharyngeus m

Thoracic: broncho-aortic

  • arch of aorta: 22.5cm from incisors: anteroposterior view
  • L main bronchus: 27.5 cm form incisors: lateral view
  • diaphragm: 40cm from incisors
232
Q

Spread of Pathological Fluids

A

supine: heptorenal
standing: rectouterine pouch

233
Q

Stomach

A

3 M layers: longitudinal, circ, oblique

rugae

Gastric canal = longitudinal fold along lesser curvature

  • Forms during swallowing
  • Accommodates the passage of liquid

covered by peritonium except: where bv run, post cardiac orifice

Anatomy Year 1 (4 decks)

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